Exercise and dietary recommendations for women with chronic pain: What's weight and race got to do with it?

Exercise and diet are beneficial for pain, yet many patients do not receive such recommendations from providers. This may be due to biases related to gender, race, and weight. We recruited medical students (N=90) to view videos of women with chronic back pain performing a functional task; patients varied by weight (overweight/obese) and race (Black/White). For each woman patient, providers rated their likelihood of recommending exercises or dietary changes. Ratings significantly differed across recommendations (F(2.75,244.72)=6.19, p<.01) in that providers were more likely to recommend flexibility exercises than aerobic exercises and dietary changes, and were more likely to recommend strength exercises than dietary changes. Results also indicated that women with obesity were more likely to receive aerobic (F(1,89)=17.20, p<.01), strength (F(1,89)=6.08, p=.02), and dietary recommendations (F(1,89)=37.56, p<.01) than were women with overweight. Additionally, White women were more likely to receive a recommendation for flexibility exercises (F(1,89)=4.92, p=.03) than were Black women. Collectively, these findings suggest that providers' exercise and dietary recommendations for women with chronic pain are influenced by the weight status and racial identity of the patient. Future studies are needed to identify the reasons underlying these systematic differences, including the stereotypes and attitudes that may be driving these effects. PERSPECTIVE: This article presents results on how patient weight and race impact providers' exercise and diet recommendations for women with chronic back pain. Provider recommendations for these modalities may be systematically biased in a way that impedes care and impacts patient functioning.